For far too long, government has not proven it has lasting solutions to the multiple factors hampering delivery of public health services to people. This is worsening—and patients are paying dearly…
In Traditional Authority Nankumba’s area in Mangochi District, patients have had to contribute money for fuel so that an ambulance can operate.
Things reached a boiling point in February when, for about two weeks, an ambulance belonging to Monkey Bay Community Hospital stood parked at Mangochi District Health Office (DHO).
This was not just ordinary parking.
The community hospital’s officials had dumped it there out of anger at the DHO’s failure to provide them with fuel to keep the ambulance running.
Sources at the community hospital told Malawi News that the fuel which the facility receives does not last them a month, which leaves patients in need of referral services paying a dear price.
Desperate to get better treatment at the district hospital, patients and their guardians have on some occasions been putting money together to fuel up the ambulance so that they can be taken to the district hospital or Zomba Central Hospital, one source said.
“After some time [of keeping the vehicle at the DHO’s office], we noticed that the Mangochi DHO could not do anything about our fuel funding situation so we went back and collected the ambulance so that people with money for fuel can contribute and continue to use it,” said one of the officials at the community hospital.
Monkey Bay Community Hospital supports five health facilities which have a combined catchment population of about 200,000 people.
The hospital, according to officials, does not provide meals to people that have been admitted – also because of limited funding.
For those that need x-ray services, the situation is difficult for them. The facility is not providing such services because there are no medical personnel to man the x-ray department.
Monkey Bay Community Hospital’s situation is shared by other health centres such as Chilipa, Namwera, Makanjira and Malombe. The main hospital itself in the district is not spared. As of Tuesday, Mangochi District Hospital had only 10 bottles of erythromycin antibiotic, according to officials at the facility.
The available paracetamol at the hospital was donated by the Central Medical Stores Trust (CMST) early in February after it had stayed for over two weeks without a single tablet of any pain killer.
Drug funding hole
Director of Health and Social Services in the district, Henry Chibowa, admitted that the facility is facing acute challenges due to inadequate funding from government.
He said in an ideal situation, with a population of more than one million people, the district would do well with over K2 billion for drug budget every year. However, government only provides K750 million for drugs.
Chibowa said the hospital’s drug budget is exhausted within seven months of each financial year such that they resort to procuring drugs from CMST [Central Medical Stores Trust] on credit.
“This means that when we receive our funding for the other year, we start by paying the debts obtained at CMST. Then we buy drugs with what is left of our budget.
“As such, we cannot rule out the possibility of patients meeting some costs themselves,” he said.
Malawi News has also gathered that apart from Mangochi, Balaka and Machinga are also struggling to provide quality medical services to people in some of their facilities.
Both Balaka and Machinga have been operating without drugs for non-communicable diseases, respiratory infections and antibiotics for some time now.
Funding hole at source
But details show that the problem begins at source.
A high-ranking contact at the Ministry of Health at Capital Hill told Malawi News that Malawi’s national drug budget is at K78 billion at the moment. But the Treasury has allocated only K24 billion for the forthcoming fiscal year.
“All district hospital pharmacies were told to compile their annual drug budget for the forthcoming year and the total came to K78 million.
“But the Ministry of Finance has provided only K24 billion, which is less than a third of what we required. This means that Malawi should brace for more challenges in the health sector in future,” the source said.
However, Deputy Minister of Health Enoch Phale gave routine assurance when we took these concerns to him.
He said government would address the challenges.
As a temporary measure, Phale said, the government has recapitalised the CMST with about K2.7 billion so that it can procure essential drugs which will be supplied to all public hospitals.
Phale also said the government has negotiated with the CMST to allow hospitals to procure drugs on emergency facility as they wait for funding for the forthcoming year.
“At the moment drug stock levels are around 40 percent in most hospitals. But at the CMST the stocks have improved such that we hope the trend will also be replicated in public health centres,” he said.
Phale however admitted that with insufficient funding in some hospitals, the facilities will continue to struggle to procure drugs from CMST.
He said his ministry is lobbying Treasury to increase funding to the Ministry of Health.
“This year we have been given slightly over 10 per cent of the national budget, which is a bit higher than what was given last year. So, the future is promising,” he said.
User fees, centralisation issues
President for Society of Medical Doctors in Malawi Victor Mithi said corruption in the public service is among factors limiting government’s expenditure on health.
“If we get rid of corruption, we will be able to have enough resources for the health sector,” Mithi said.
He suggested the need for the government to allow district health offices to decide how best they can improve their hospitals without central government’s control.
“For instance, councils can have powers to devise awareness means that can pave way for user fees in public health facilities as a way of raising funds to run the facilities effectively,” he said.
However, Executive Director for Malawi Health Equity Network (Mhen), George Jobe, argued against user fees in public hospitals.
He said the problems in the health sector are deeper than lack of funding.
He said government needs to come out clear and accept that the sector needs a complete overhaul.
He also urged government to find ways of regulating private hospitals so that they have a clear source of medical supplies as a way of curbing theft of drugs in public health facilities.